Spontaneous retropharyngeal haematoma attributable to Epstein-Barr virus infection.

Life-threatening sequelae of Epstein-Barr virus infection are uncommon but may present as: local pharyngeal manifestations, splenic rupture, neurological and haematological disorders and altered hepatic function. We present a case of retropharyngeal haematoma with posterior hypopharyngeal wall necrosis, thrombocytopenia and altered clotting function as a result of Epstein-Barr virus infection. A review of the literature on retropharyngeal haematoma reveals this to be the only recorded case which can be directly attributed to Epstein-Barr virus infection.

Snoring, apnoea and ENT symptoms in the paediatric community.

This study was designed to determine the prevalence of snoring and assess the extent of associated ENT symptoms in children up to 10 years of age. A questionnaire was presented to the parents of 245 children chosen at random from the General Practice list of the town of Frome, Somerset, UK. The prevalence of snoring was found to be 27%. This increased to 47% in the presence of an upper respiratory infection. Snoring was found to be significantly (P < 0.001) associated with a history of poor hearing, restless sleep, and having a cold. Less significant (P < 0.01) associations occurred with parental smoking, eczema, sleep talking, moving around the bed at night, sore throats, having a runny nose and mouth breathing. Snoring is a common symptom in children up to 10 years of age. Without evidence of other ENT disease the snoring child does not require referral to an ENT department for further investigation.

Overnight pulse oximetry in normal children and in children undergoing adenotonsillectomy.

This study investigates the hypoxia that has been described during sleep in children admitted for adenotonsillectomy. Two hundred and twenty-two randomly selected children and 33 children awaiting adenotonsillectomy had overnight pulse oximetry performed at home. Children undergoing surgery had a second study in hospital on the eve of surgery and a third at home 3 months post-operation. Analysis of pulse oximetry data failed to detect a clinically significant difference in oxygen saturation levels between these populations. Snoring is reported in 76% of children undergoing adenotonsillectomy and 11% of the normal population. Sleep apnoeic episodes occur in 52% of children prior to surgery compared with 8% of the normal population. Overnight pulse oximetry has failed to differentiate children with symptoms suggestive of obstructive sleep apnoea from the normal population. Its use as a screening procedure should be used with caution until more is known about its ability to predict significant disease.

Overnight pulse oximetry in snoring and non-snoring children.

The effect of snoring on overnight pulse oximetry recordings in the paediatric community was investigated. A random sample of 222 children up to 10 years of age from the town of Frome, Somerset, UK, had overnight pulse oximetry performed in the home environment. The oximetry recordings obtained from 58 snoring and 164 non-snoring subjects were compared. No clinically relevant difference in oxygen saturation level could be detected between these two groups of children. In conclusion, snoring in children up to 10 years of age is common, 11% often snore. It is not associated with hypoxia as measured by overnight pulse oximetry. This would suggest that surgical intervention for the symptom of snoring alone is not indicated.

Dental prostheses and the impacted swallowed foreign body.

A common belief exists that patients who wear false teeth are more likely to present with an impacted swallowed foreign body than those with a normal dentition. This study reviewed a series of 65 patients (with data available from 45) who presented with a swallowed impacted foreign body which required endoscopic removal under general anaesthesia. With the aid of a questionnaire the incidence of dental prostheses in these patients was determined. The number of patients in our study who had either false teeth or natural dentition was compared with the expected age-related incidence of wearing dental prostheses in the general population of the United Kingdom. There were no statistically significant differences between these groups. Patients presenting with an impacted swallowed foreign body are no more likely to be wearing false teeth than any other member of the population.

Fractured-nose reduction under local anaesthesia. Is it acceptable to the patient?

This article examines patients' acceptance of fractured-nose reduction under local anaesthesia, both objectively and subjectively. At each stage of the reduction the level of the discomfort, the patients' experiences were recorded. The success rate of complete reduction of the nasal fracture was found to be 71% and this was similar to that obtained in other studies that have used general anaesthesia. An overall level of discomfort for the procedure in terms a layman can understand was obtained by comparing the manipulation with that of having a tooth filled at the dentist. Sixty-three percent of the patients said that the nasal fracture reduction was no worse or the same as a dental filling. Our study showed that 96% of patients would be willing to undergo the same local anaesthetic procedure if they fractured their nose a second time. We conclude that it is possible to reduce the majority of fractured noses adequately with little inconvenience to the patient under local anaesthesia, and so we recommend that this procedure should be considered in the first-line treatment of the displaced fractured nose.